Provider Demographics
NPI:1891786117
Name:PASTORE, VINCENT LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:LOUIS
Last Name:PASTORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E INNES ST STE A5
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-5008
Mailing Address - Country:US
Mailing Address - Phone:704-677-2900
Mailing Address - Fax:
Practice Address - Street 1:120 E INNES ST STE A5
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5008
Practice Address - Country:US
Practice Address - Phone:704-677-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11246103TC0700X
NC2019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
04358OtherBLUE CROSS
5368504OtherAETNA
NC6000419Medicaid